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Clinical Medicine 2 > Exam 1 - CAD, angina > Flashcards

Exam 1 - CAD, angina Flashcards

1
Q

What happens in the coronary arteries in CAD?

A

Increased number of abnormal smooth muscle cells with deposits of cholesterol and other substances.

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2
Q

What can happen with increased vascular resistance due to a clot?

A

Rupture the clot which leads to an MI

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3
Q

What is the Framingham Risk Score?

A

10 year risk of CAD. Doesn’t include FHx or DM.

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4
Q

Some common CAD risk factors?

A

Over 65 y/o, DM (CAD equivalent), 1st degree relative with premature MI (women under 65, men under 55), Metabolic Syndrome, cocaine use

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5
Q

Metabolic Syndrome criteria?

A 
3 or more
Abdominal/central obesity
TG above 150
Men HDL under 40, women HDL under 50
HTN
Fasting glucose above 110
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6
Q

What is Primary Prevention of CAD?

A

Don’t have CAD, want to prevent CAD.

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7
Q

How to achieve CAD primary prevention?

A

Normal, Ideal weight, physical activity, Mediterranean diet, don’t smoke, BP under 140/90 or 130/80 if positive risk factors, glycemic control, daily ASA with high risk, small EtOH consumption

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8
Q

3 categories of CP?

A
  1. Classical/Typical Angina=SOB, substernal pain, typical crushing quality, 5-15min in duration, better with rest or ntg
  2. Probable/Atypical Angina=CP with 2/3 of typical
  3. Nonanginal/Nonischemic=1 or none of typical
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9
Q

How long does Classical/Typical Angina last for? What makes it better?

A

5-15min duration. Better with rest or NTG

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10
Q

General Physical Exam with CAD?

A

Often normal. Abdominal obesity, sweaty, SOB with minimal exertion.

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11
Q

Apple Body vs Pear Body risk?

A

Apple Body=increased risk. Carries weight in abdomen.

Pear Body=decreased risk. Fat in butt and thighs.

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12
Q

Peripheral pulses in CAD?

A

Decreased from PAD

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13
Q

Bruits in CAD located here?

A

Carotid, renal, aorta, or femoral arteries

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14
Q

EKG in early or stable CAD?

A

Normal in early or stable CAD.

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15
Q

Pathlogic Q-wave demonstrates what?

A

Prior MI

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16
Q

Non-specific ST-T abnormalities demonstrate what?

A

Previous or active ischemia

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17
Q

Describe is Angina Pectoria?

A

Chest pain attributed to myocardial ischemia. Oxygen supply/demand mismatch.

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18
Q

Describe Angina Equivalent

A

Sx other than chest pain attributed to myocardial ischemia: SOB, dizzy, nausea, fatigue

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19
Q

What are the 4 main oxygen demand factors?

A
  1. HR
  2. SBP
  3. Myocardial wall tension/stress
  4. Myocardial contractility
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20
Q

Describe Chronic Stable Angina?

A

CP w/exertion for 5-15 min. Centrally located. Predictable and reproducable. Relieved w/rest and/or NTG. Fatigue, presyncope.

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21
Q

Describe Unstable Angina

A

Sx at rest or less exertion than baseline. Plaque increasing.

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22
Q

What is the main method of diagnosing CAD?

A

Stress testing

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23
Q

Angina and stress testing appropriate and CI?

A

Appropriate in stable angina. Contraindicated in unstable angina.

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24
Q

Indication for Stress Testing?

A

PT with Sx suggesting stable angina w/intermediate pretest probability of dz.

25
Q

What sort of scan for CAD do very obese patients get?

A

PET scan

26
Q

What is the first-line stress test? Who gets it?

A

Exercise tolerance test. Must have normal EKG and low-to-moderate CAD risk

27
Q

What does a Stress Echo do?

A

Looks for stress-indiced regional wall abnormalities to location lesion in coronary arteries. Done at rest and after stress.

28
Q

What is Radionucleotide Myocardial Perfusion Imaging?

A

Nuclear med test to locate lesion in artery. No color update=poorly perfused tissue. Very sensitive, very expensive!

29
Q

3 types of Acute Coronary Syndrome?

A
  1. Unstable Angina
  2. NSTEMI
  3. STEMI
30
Q

What is the classic ACS presentation?

A

Early morning substernal chest pressure radiation to left/both arms and/or jaw, sense of doom, SOB, N/V, diaphoresis, light-headed, 20m-1h

31
Q

Describe Unstable Angina ACS? (Hint: ischemia, Troponins, plaque, EKG?)

A

ACS with ischemic symptoms. No increased cardiac biomarkers. Unstbale plaque, no rupture, artery not yet obstructed.

EKG=norm or S-T depression or T-wave inversion

32
Q

Describe NSTEMI ACS? (Hint: ischemia, Troponins, plaque, EKG?)

A

Increased cardiac biomarkers. Unstable plaque with or without rupture. Significant narrowing of artery.

EKG=No S-T elevation. S-T depression. Non-Q-Wave-MI.

33
Q

Describe STEMI ACS? (Hint: ischemia, Troponins, plaque, EKG?)

A

Positive cardiac biomarkers. Plaque ruptures and complete occlusion of artery.

EKG=greater than 2mm ST elevation in two contiguous precordial leads OR greater than 1mm ST elevatio in two contiguous other leads.
Q-Wave-MI. New LBBB is MI until ruled out. Reciorcal changes.

34
Q

What is most important factor in diagnosing ACS?

A

Story is #1 most important factor

35
Q

What to do with EKGs during ACS?

A

Compare new ro old

36
Q

Which cardiac biomarkers show in blood first?

A

CK-MB first. TnI and TnT later.

37
Q

EKG leads for LAD occlusion?

A

V2, V3, V4. Anterior.

38
Q

EKG leads for lateral LCA occlusion?

A

I, aVL, V5, V6

39
Q

EKG leads for RCA inferior occlusion?

A

II, III, aVF

40
Q

EKG leads for RCA ventral occlusion?

A

aVR, VI

41
Q

EKG leads for RCA Posterior occlusion?

A

ST depresison in V2-V4

42
Q

When to revascularize UA/NSTEMI?

A

Hemodynamically unstable/cardiogenic shock
Severe LV dysfunction or severe HF
Recurrent or persistent angina despite max meds
New or worse mitral regurg
Sustained ventricular arrythmias

43
Q

Tx of STEMI?

A 
Morphine for CP (esp if NTG not working)
O2 is SpO2 less than 90%
Nitrates for CP, 0.4mg SL q5m x3 then morphine
ASA 324/325mg
Anticoagulate, K and Mg mgt
44
Q

What 3 tx improve outcomes of STEMI?

A
  1. Beta-blocker=Metoprolol. Prevent tissue ischemia and vent arrythmias
  2. High dose statin=80mg Atoravastatin
  3. Anti-platelet therapy
45
Q

Why give anticoagulants during and after stenting?

A

Prevent stents from clotting

46
Q

Time for reperfusion in STEMI?

A

90 minutes door to balloon!

47
Q

Who gets Prinzmetal Angina (Variant Angina)?

A

Younger PTs. FHx w/genetic factors.

48
Q

Risk factors for Prinzmetal Angina (Variant Angina)?

A

Drug use, insulin resistance, smoking

49
Q

Patho of Prinzmetal Angina (Variant Angina)?

A

Vascular smooth muscle hyperreactive causing focal spasm of major coronary artery. High grade transient artery obstruction

50
Q

Prinzmetal Angina (Variant Angina) and CV risk factors?

A

Few CV risk factors

51
Q

What can happen if Prinzmetal Angina (Variant Angina) occurs for long enough?

A

MI

52
Q

Triggers for Prinzmetal Angina (Variant Angina)?

A

Changes in autonomic variability, drugs (ephedrine, cocaine, pot), Mg2+ deficiency

53
Q

When does Prinzmetal Angina (Variant Angina) occur?

A

Midnight to early morning

54
Q

Prinzmetal Angina (Variant Angina) PE? EKG?

A

Angina at rest.

Transient 15m ST segment elevation. Normal after episode.

55
Q

Tx for Prinzmetal Angina (Variant Angina)?

A

NTG is key to treatment during episodes.

Long-lasting nitrates and CCBs to prevent vasoconstriction and promote vasodilation or coronary arteries.

Statins, Mg supplementation, and PCI w/stent (rare).

56
Q

DM is what sort of risk in CAD?

A

“CAD equivalent”

57
Q

MI in DM presents how?

A

Atypically. Nausea, feeling “off”

58
Q

What tests if need to know lesion location?

A

Imaging.

Echo, SPECT, PET-CT

Clinical Medicine 2 (14 decks)

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